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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(12): E1447-E1452
DOI: 10.1055/a-2441-2543
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Spinal anesthesia for endoscopic submucosal dissection of large rectosigmoid lesions: Feasibility study

Giuliano Francesco Bonura‡
1   Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, Modena, Italy (Ringgold ID: RIN18067)
,
Paolo Biancheri‡
1   Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, Modena, Italy (Ringgold ID: RIN18067)
2   Gastroenterology and Digestive Endoscopy Unit, Santa Croce e Carle Hospital, Cuneo, Italy
,
Joachim Rainer
1   Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, Modena, Italy (Ringgold ID: RIN18067)
,
Paola Soriani
1   Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, Modena, Italy (Ringgold ID: RIN18067)
,
Enrique Rodriguez de Santiago 
3   Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Madrid, Spain (Ringgold ID: RIN16507)
4   Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcala, Alcala de Henares, Spain (Ringgold ID: RIN16720)
5   Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Centro de Investigación Biomédica en Red, Madrid, Spain (Ringgold ID: RIN540869)
,
Arianna Parrella
1   Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, Modena, Italy (Ringgold ID: RIN18067)
,
Alice Campioli
6   Anesthesiology and Intensive Care Unit, Azienda USL Modena, Modena, Italy (Ringgold ID: RIN18067)
,
Emmanuele Guerra
6   Anesthesiology and Intensive Care Unit, Azienda USL Modena, Modena, Italy (Ringgold ID: RIN18067)
,
Eugenia Gualdi
6   Anesthesiology and Intensive Care Unit, Azienda USL Modena, Modena, Italy (Ringgold ID: RIN18067)
,
Alessandro Pignatti
6   Anesthesiology and Intensive Care Unit, Azienda USL Modena, Modena, Italy (Ringgold ID: RIN18067)
,
Mauro Manno
1   Gastroenterology and Digestive Endoscopy Unit, Azienda USL Modena, Modena, Italy (Ringgold ID: RIN18067)
› Author Affiliations Clinical Trial: Registration number (trial ID): NCT06316401, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Observational retrospective
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Abstract

Background and study aims Colorectal endoscopic submucosal dissection (ESD) is often challenging and time-consuming. Prolonged sedation and general anesthesia are associated with a relevant risk of anesthesia-related adverse events (ARAEs), especially in elderly and frail patients. Spinal anesthesia (SA), a simple technique providing analgesia and motor block without systemic drug administration, has never been described in gastrointestinal endoscopy. We assessed the feasibility of SA in colorectal lesion ESD.

Patients and methods We retrospectively collected data on all consecutive patients who underwent ESD for colorectal laterally spreading tumors (LSTs) under SA in our center during the last 3 years. We evaluated the rates of technical success, i.e. ESD completion under SA without need of conversion to deep sedation or general anesthesia, and ARAEs after SA.

Results ESD under SA was performed on 20 rectosigmoid LSTs ≥ 35 mm. Technical success was achieved in 95.0% of cases (19/20), while one patient (5.0%) required conversion to deep sedation. Two patients (10.0%) experienced acute urinary retention that was successfully treated with temporary catheterization.

Conclusions Our initial experience suggests that SA for ESD of large rectosigmoid LSTs is feasible, and it may prove to be a valuable option, especially for elderly and frail patients.

Keywords

Quality and logistical aspects - Sedation and monitoring - Endoscopy Lower GI Tract - Polyps / adenomas / ... - Endoscopic resection (polypectomy, ESD, EMRc, ...)


Publication History

Received: 22 May 2024

Accepted after revision: 18 September 2024

Accepted Manuscript online:
14 October 2024

Article published online:
17 December 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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